Unplanned pregnancies can prevent girls from finishing their schooling or have other negative effects on the health of a girl as well as having an impact on the whole family. Unplanned pregnancies may result in parents not being able to afford the cost of having a child, as well as the existing children in the family suffering from hunger, neglect or abandonment.
Contraception is the word used to describe the prevention of pregnancy. Some girls might not want to have children at all or might want to wait until they are older before they think about having children. If you are thinking about having sex and you don’t want to have a child as a result of this, then you need to think about contraception.
Before you have sex, you need to think the most appropriate form of contraception for you so that you can avoid unplanned pregnancy, HIV and other sexually transmitted infections (STIs). You have many options from which to choose, and you can discuss contraception options with your partner, or make a decision on your own about what methods you want to use.
There are different ways to prevent pregnancy but only one way to prevent HIV. You need to use a condom every time you have sex to prevent HIV and other STIs from passing from one person to another. Using a condom together with another form of contraception ensures that you are protected from both HIV and from pregnancy.
(The information in this section is adapted from the Zazi Programme Guide, available at www.zazi.org.za)
Common contraceptive methods
The male condom is a covering made to fit over a man’s erect penis. Most condoms are made of latex rubber. Some condoms are coated with a dry lubricant or with spermicide. When used correctly, the condom keeps semen inside itself and keeps sperm, viruses and bacteria out of the vagina. The condom also stops any viruses and bacteria in the vagina from entering the penis, so it protects the woman from pregnancy and both partners from getting HIV and other STIs.
The female condom is a soft, polyurethane tube with one closed end and one open end. Both ends have a flexible ring or rim. The ring at the closed end is inserted deep into the vagina and rests over the cervix. The ring at the open end remains outside the opening of the vagina. The closed end of the female condom acts as a barrier to prevent semen, sperm, viruses and bacteria from entering the vagina and stops any viruses and bacteria in the vagina from entering the penis, so it protects a woman from pregnancy and both partners from getting HIV and other STIs.
There are ways to introduce the condom into the sex act that may heighten sexual pleasure.
Some people who use condoms experience an allergic reaction to latex or lubricant, which causes itching, burning or swelling. Any problems with condoms should be discussed with a healthcare provider.
Hormonal contraceptives are made from the artificially synthesised hormones oestrogen and progestin, which stop the body from ovulating (releasing an egg) and change the mucous membrane (lining) of the cervix, making it difficult for the sperm to enter the uterus and fertilise an egg, or making the lining of the womb inhospitable for the implantation of a fertilised egg. There are different kinds of hormonal contraceptives: Injectables/injection: The injection prevents the release of an egg from the ovary and thickens the mucous membrane (lining) of the cervix, making it difficult for sperm to pass through into the uterus. The injection must be given either every two months (NET-EN) or every three months (DMPA), depending on the type used.
Oral contraceptive pill: These pills contain hormones, which prevent the release of an egg from the ovary. They also thicken the mucus (fluid) around the cervix to prevent sperm from passing into the uterus and affect the lining of the uterus so that a fertilised egg does not implant there. The pill comes in a 28- or 21-day pack. Different types of the pill are available at local clinics and will be prescribed depending on the needs of the girl using it. Forgetting to take the pill, taking certain other medicines, and vomiting or having diarrhoea after taking the pill may make it less effective in preventing pregnancy. If this happens, you will need to use condoms until after your next period, to make sure that you do not get pregnant.
These are small plastic capsules of hormones that are inserted under the skin by a healthcare provider. They are long-lasting and reliable and should be removed by a healthcare provider and replaced after five years, depending on the implant. Some of the hormonal contraceptive methods have side-effects, such as changes to their menstrual period, headaches, dizziness, breast tenderness or weight gain. These are not dangerous, and most side-effects will go away after a few weeks. Speak to your healthcare provider if these continue or become uncomfortable.
Intra-uterine device (IUD or cu-ICD)
This is a small plastic and copper device that is placed inside the uterus (womb) by a healthcare provider. The IUD prevents the sperm and egg from meeting and prevents pregnancy. It is a very reliable, long-term method of contraception and can last for up to five years. If you are using an IUD, you should have a check-up at the clinic every year, and the device must be removed after five years by a healthcare
A Levonorgestrel-releasing intra-uterine system (LRN IUS) is a hormone-releasing, soft, plastic T-shaped device that is inserted in the uterus. It is also known as the ‘hormonal coil’. The IUS releases a low dose of hormones into the womb, where it has a contraceptive effect. It can last for up to five years and must be inserted and removed by a healthcare practitioner.
Sterilisation is surgery to prevent a person from being fertile. It is a permanent contraceptive method for both women and men. Any person who is 18 years or older, who is capable of consenting, may be sterilised at his or her request. It is a short and simple operation that does not affect a person’s sex life, other than giving peace of mind about unwanted pregnancy. Sterilisation is a very effective, safe and permanent method for couples who know that they do not want to have any or more children.
Sterilisation for women: The sterilisation procedure for women is called tubal ligation. The fallopian tubes that carry the eggs from the ovaries to the uterus (womb) are tied or blocked. The eggs are not released, and they stay in the fallopian tubes until they die and are absorbed by the body. Because an egg cannot be fertilised by the sperm, pregnancy is prevented.
Sterilisation for men: The sterilisation procedure for males is called a vasectomy, where one or two small openings are made in the skin near the testicles. The vas deferens (sperm tubes), which carry sperm from each testicle, are cut and tied. The sperm cannot pass to the penis and is reabsorbed by the body. The operation is not effective immediately, and it is important to use another contraception method for three months after the procedure or for the next 15 to 20 times that the man has sex. A confirmatory test (sperm count) is necessary to ensure that the sperm is cleared from the tubes before a man can safely have unprotected sex without the risk of getting his partner pregnant.
Natural methods of contraception
There are some methods to prevent pregnancy that have been used for many generations and which do not require the use of medicines, operations or other modern contraceptives.
Abstinence: Abstinence means not having sex and avoiding penetration or any contact of the penis near the vagina. Complete sexual abstinence is the most effective means of protection against pregnancy, HIV and other STIs.
Fertility awareness-based methods (the rhythm method): These involve knowing when you are in the fertile period of your menstrual cycle and using condoms during sex or not having sex at all on these fertile days. The fertile days are usually from day nine to day 15 of the menstrual cycle (counting from the first day of bleeding of the period). However, if you have irregular periods then you cannot be sure about your fertile days. It is possible that a man’s sperm can remain alive and active in the vagina for up to five days after having sex, so this method does carry a high risk of falling pregnant.
Traditional methods: Traditional methods of enjoying sexual pleasure while preventing pregnancy include rubbing against each other or having sex with clothes on, thigh sex (where the penis does not penetrate the vagina), and the withdrawal method, where a man removes his penis from the vagina before ejaculating. However, these methods require that both partners are extremely careful that the man does not ejaculate in or near the vagina, to prevent pregnancy and HIV. Although some people may use traditional medicines and washes (douches) to prevent pregnancy, these are not proven to be effective and the modern methods discussed above are safer options. Home remedies that include washing the vagina, drinking certain liquids, coughing, lying on the stomach, showering or standing up quickly will not prevent pregnancy, HIV and other STIs after having unprotected sex.
If you have unprotected sex or use another method of contraception that fails, such as condom that bursts, then you can get emergency contraception from a clinic or pharmacy to prevent pregnancy after having sex.
Emergency contraceptive pill (ECP): Also known as the ‘morning after pill’, this is used to prevent unintended pregnancy following unprotected sex by preventing an egg from being released from the ovaries so that it cannot be fertilised by sperm that has entered the vagina. The ECP must be taken as soon as possible after sex. The earlier it is taken, the more likely it is to be effective. To be effective, it must be taken within 120 hours (five days) of having sex and can only be used to prevent pregnancy after one act of unprotected sex. The ECP is safe if used more than once, but it should not be used as a regular contraceptive, as it is not as effective as the longer-lasting methods.
Emergency IUD: Another option to prevent pregnancy after having unprotected sex is to have a copper IUD inserted into the uterus up to five days after having unprotected sex. Having an IUD inserted may stop an egg from being fertilised or implanting in the womb. This must be inserted by a healthcare professional and can be done at most clinics or by a private doctor. If you have an IUD fitted as emergency contraception, it can be left in as your regular contraceptive method.